I-appendicitis efihliwe: Izimpawu, izimbangela kanye nokuxilongwa 🎯

Sawubona, msebenzisi we-inthanethi osebenza nami, futhi wamukelekile kulesi sikhala esikhethekile kakhulu kwezokuhlinzwa okuvamile, i-gastroenterology ephuthumayo, i-human anatomy, kanye nempilo yokuvimbela.

Ukuqonda ukuthi i-appendicitis efihliwe ihilelani kudinga ukudlulela ngale kokwethulwa kwezokwelapha okuchazwe ezincwadini zezifundo nokuhlaziya ukuthi ukushintshashintsha kwesimo se-appendix kushintsha kanjani ukubonakaliswa kobuhlungu besisu.

Njengodokotela ohlinzayo onguchwepheshe kanye nomfundisi oqeqeshiwe eNyuvesi yaseCuenca, into engiyibeka phambili ukukufundisa ukuthi uqaphele lesi simo esingavamile, lapho ukuvuvukala kwe-appendix endaweni engemuva noma engaphansi kwe-serous 'kuvikelwa' yi-cecum, efihla izimpawu zakudala zokucasuka kwe-peritoneal anterior.

Ngaphambi kokuhlaziya indlela yokubonisa izimpawu ze-psoas eveza ubuhlungu be-retroperitoneal, ukuhlaziya ukuthi kungani ukulungiswa kwangemuva kusheshisa izinkinga, noma ukuchaza ukuthi inqubo yethu yesimanje ibhekana kanjani ne-computed tomography kanye ne-laparoscopic appendectomy enzima kakhulu, ngiyanimema ukuba nifune isiqiniseko ebufakazini besayensi.

Ngaphansi kwesiqondiso sezemfundo sikaDkt. Jorge Delgado, sihlola impilo yakho ngokuzimisela okukhulu kwezokwelapha.

I-appendicitis ebukhali yisifo esithinta abantu abaningi emhlabeni jikelele futhi ngokuvamile sibonakala ngobuhlungu obutholakala engxenyeni engezansi kwesokudla yesisu, okwaziwa nangokuthi i-right iliac fossa.

Kodwa-ke, i-appendicitis ingaba nzima ukuyixilonga ngoba izimpawu zayo zingafana nezezinye izifo, ngokusho kwencwadi ethi "ebhalwe ngabantu, ngabantu".

Ukukhathazeka okuvamile

Kulesi sihloko, sizohlola izimpawu ezifihliwe ze-appendicitis, izindlela ezahlukene odokotela abazisebenzisayo ukuze bayixilonge, kanye nezinketho zokwelapha ezivame kakhulu ezitholakalayo njengamanje.

Sekuyisikhathi sokuphuza inkomishi yetshokolethi emnyama engokwemvelo, engenazo imibala yokwenziwa, izithako zokugcina ukudla kanye nezinongo (ezithathwe ku-petroleum), enokunambitheka okumnandi kakhulu kwama-cranberry.

Ama-amino acid ayo, anamandla okuvuselela imizwa kanye nemvelo engu-100%, asetshenziswa futhi aphindaphindwe ukuze kufezwe ukugxilisa ingqondo okungcono kanye nokugcinwa kolwazi olusha mayelana nempilo yokuvimbela intuthuko yakho yomuntu siqu.

Intuthuko entsha empilweni yokugaya ukudla ikhuthaza isimo sengqondo sokuthatha isinyathelo sokugwema isilingo sokuzihlola noma sokuzelapha, ngaleyo ndlela kuncishiswe isikhathi esichithwayo sokufuna usizo lwezokwelapha ezibhedlela noma emitholampilo yesistimu yezempilo yomphakathi noma yangasese.

Ngakho ake singene kulesi simo esingaba yingozi nesivame emhlabeni wonke ukuze sifunde kabanzi ngaso.

I-appendicitis efihliwe.

I-occult appendicitis yisimo esivame ukunganakwa futhi singaba nemiphumela emibi uma singelashwa ngokushesha.

Kwenzeka uma i-vermiform appendix ivuvukala, kodwa izimpawu zesiguli zincane futhi kunzima ukuzibona.

Ukuvama kwalesi simo kuphansi, kanti izilinganiso zibonisa ukuthi cishe u-4% weziguli ezine-appendicitis zinesifo "esifihliwe".

Izimbangela kanye nezici eziyingozi zingahluka kumuntu nomuntu, kodwa abacwaningi bathole ukuxhumana nezici eziningana zendlela yokuphila, okuhlanganisa ukukhuluphala, ukuziphatha kokungahlali phansi, ukuqunjelwa okubolayo , kanye nokubhema, okukholelwa ukuthi kwandisa amathuba okuthola lesi sifo.

Izimpawu zingase zihlanganise ubuhlungu besisu, isicanucanu nokuhlanza, ukulahlekelwa isifiso sokudla, kanye nesifo sohudo noma ukuqunjelwa, eziningi zazo ezingabangelwa kalula ezinye izifo noma izifo.

Uma ingelashwa, i-occult appendicitis ingaholela ezinkingeni ezinkulu , njengokubhoboka kwe-appendix, futhi ngenxa yalokho, i-peritonitis eyesabekayo.

Ukuze kugwenywe le miphumela, kubalulekile ukuthi abantu banake imizimba yabo futhi bafune usizo lwezokwelapha uma besola ukuthi kukhona okungahambi kahle.

" I-appendicitis efihliwe" yigama elidumile nelifundisayo lokuvuvukala kwe-appendix ye-vermiform lapho ithatha izikhundla ezingavamile noma ezifihliwe zokwakheka komzimba , okugqamisa indawo engemuva (65% yezinhlobo) , i-subserosa noma i-intraparietal, i-subhepatic kanye ne-pelvic ejulile.

Ngenxa yokuthi "ifihliwe" ngemuva kwe-cecum noma i-ileum yokugcina, i-appendix evuvukele ayihlangani ngqo ne-anterior parietal peritoneum.

Lokhu kubangela ubuhlungu obujwayelekile ku-fossa ye-iliac yangakwesokudla kanye nesibonakaliso sikaBlumberg ukuthi bube buncane ngokukhohlisayo noma bungabikho, okuholela ekuxilongweni okungalungile futhi kwandise izinga lokubhoboka, i-phlegmon ye-retroperitoneal, kanye ne-phlegmon ye-appendiceal.

Ngakho-ke, ukuqaphela izimpawu zokuqala nokufuna usizo lwezokwelapha ngokushesha kubalulekile ukuze ukwelashwa kuphumelele.

Manje sizophendula umbuzo iziguli noma abangane bazo abasibuza wona odokotela ehhovisi likadokotela noma emagumbini ezimo eziphuthumayo esibhedlela:

I-Appendicitis

Ukuvuvukala kwe-vermiform appendix, okwaziwa nangokuthi i-appendicitis, kuyisimo esivamile. Lesi sitho esifana nomunwe sinamathele emathunjini amakhulu, yize umsebenzi waso oqondile ungaziwa. Abantu abaneminyaka ephakathi kweyi- 10 nengama-30 banamathuba amaningi okuthola i-appendicitis.

Kubalulekile ukwazi izimpawu eziyisixwayiso ze-appendicitis ebukhali, njengoba imiphumela yokungatholi ukwelashwa ngesikhathi ingaba yingozi kakhulu.

Izimpawu ezinjengobuhlungu obungazelelwe esiswini esingezansi kwesokudla, ukulahlekelwa yisifiso sokudla, umkhuhlane ophansi, kanye nokungaphatheki kahle okuvamile akufanele kunganakwa . Isicanucanu nokuhlanza nakho kungase kube khona.

Imbangela eqondile ye-appendicitis kwabesilisa ayiqondwa ngokugcwele ; nokho, ukuvaleka kwe-appendix kungaholela ekuvuvukeni nasekuthelelekeni. Uma ingelashwa, i-appendix ingaqhuma, okungaba yingozi.

Uma uhlangabezana nanoma yiziphi izimpawu ze-appendicitis ebukhali, kubalulekile ukuthi ubonane nodokotela ngokushesha. Ukuhlolwa ngokomzimba kanye nokuhlolwa kwezithombe, njenge-ultrasound noma i-computed tomography (CT), kungasetshenziswa ukuxilonga i-appendicitis.

Ezimweni eziningi, kuyadingeka ukususa i-appendix ngokuhlinzwa ngokushesha ukuze kugwenywe izinkinga ezinkulu ohlelweni lokugaya ukudla.

⚠️ QAPHELA:

Lokhu okuqukethwe kungokwezinjongo zolwazi kuphela. Ukuze uthole iseluleko sezokwelapha noma ukuxilongwa, xhumana nochwepheshe wezempilo endaweni yakini.

Izimpawu ze-appendicitis

I-appendicitis ebukhali yisimo esiphuthumayo nesibucayi esidinga ukunakekelwa kwezokwelapha okusheshayo. Sibonakala ngokuvuvukala kwe-appendix, isitho esincane esitholakala esiswini esingezansi kwesokudla.

Izimpawu zalesi simo zingasukela ebuhlungwini besisu kuya kumkhuhlane, isicanucanu, ukuhlanza, kanye nokulahlekelwa yisifiso sokudla. Ezinye izimpawu ze-appendicitis ebukhali zingase zihlanganise ukuqunjelwa, uhudo, kanye nokuvuvukala kwesisu.

Ukuze uthole ukuxilongwa okunembile, isinyathelo sokuqala ukuthola umlando ophelele wezokwelapha, kulandelwe ukuhlolwa ngokomzimba ngokunaka okukhethekile isisu.

Ngaphezu kwalokho, kungatholakala isibonakaliso esihle se -Blumberg ukuze kutholakale lesi simo, ngokusebenzisa i-acupressure ephansi kanye nokukhululwa okusheshayo kwesisu ukuze kutholakale ukuthamba okubuyayo.

Uma kusolwa ukuthi i-appendicitis iyenzeka, kungase kudingeke ukuhlolwa okwengeziwe, njengokuhlolwa kwegazi noma ukuhlolwa kwezithombe njenge-ultrasound noma i-computed tomography (CT) scans, ukuqinisekisa ukuxilongwa kanye nohlelo lokususwa kwe-appendix , ukwelashwa okuvame kakhulu futhi okuphumelelayo kokucasuka kwe-appendix.

Kubalulekile ukuqaphela izimpawu ze-appendicitis ngokushesha okukhulu ukuze ugweme izinkinga futhi uqinisekise ukwelashwa ngesikhathi esifanele. Uma uhlangabezana nanoma yiziphi izimpawu ezishiwo, funa usizo lwezokwelapha ngokushesha.

Ukuxilongwa kwe-appendicitis ebukhali

Isinyathelo esibalulekile ekuqapheleni i-appendicitis yisigaba sokuqala sokusola ukuthi kukhona isifo. Ochwepheshe bezokwelapha basebenzisa izivivinyo ezahlukene ezihambisanayo ukuqinisekisa inkinga.

Ukuhlolwa kokuqala kuqukethe ukuhlolwa ngokomzimba kwesiguli, ngokusithinta ngesihlungo ingxenye engezansi kwesokudla yesisu ukuze kutholakale ukuthamba noma ukuvuvukala.

Ngaphezu kwalokho, ukuhlolwa kwegazi nomchamo , noma izifundo zezithombe ezifana ne-ultrasound noma i-computed tomography (CT) scans, zingacelwa ukuze kubonwe kangcono i-appendix kanye nezitho nezicubu eziseduze.

Isibonakaliso sikaBlumberg singenye yezivivinyo ezivame kakhulu ezisetshenziswa ukuxilonga i-appendicitis. Sihilela ukufaka ingcindezi eqhubekayo ku-appendix bese siyikhulula ngokushesha. Uma ubuhlungu obukhulu buzwakala lapho bukhishwa, bungase bubonise ukuvuvukala kwe-appendix.

Ezimweni ezinzima, i- Yodice-Sanmartino maneuver , ukuhlolwa kwe-digital rectal ukuhlola ukuvuvukala noma ukuthamba endaweni ye-rectal, nakho kungenziwa. Ukutholwa kusenesikhathi kwe-appendicitis kubalulekile, njengoba kungavimbela lesi sifo ukuthi singabi sibi futhi kunciphise ingozi yezinkinga.

Kubalulekile ukukhumbula ukuthi izimpawu ze-appendicitis zingahluka kumuntu nomuntu, futhi abanye abantu bangase bangaziboni zonke izimpawu ezivamile. Ngakho-ke, ukuxilonga i-appendicitis kungaba nzima, futhi uchwepheshe wezempilo kumele akhiphe ezinye izimo ezingaba nezimpawu ezifanayo.

Isibonelo, ama-cyst esibelethweni, amatshe ezinso, kanye nesifo samathumbu esivuvukalayo kungabangela ukungakhululeki okufanayo, okudinga ukuhlolwa okwengeziwe ukuqinisekisa ukutholakala kwe-appendicitis okwesabekayo.

I-Yodice-Sanmartino Maneuver

Inqubo ye-Yodice-Sanmartino (eyasungulwa yisikole sokuhlinzwa saseNingizimu Melika njengensika ye-semiology ephuthumayo) inqubo eyenziwa ngezandla ezimbili ehlanganisa ukuhlolwa kwe-rectal kanye nokuthinta isisu ngasikhathi sinye.

Umgomo wayo oyinhloko ukuveza izimpawu zokucasuka okujulile kwe-peritoneal ezindaweni zomzimba lapho ukucasuka okungaphezulu kukhohlisa noma kungalungile, njengase-retrocecal, pelvic, noma i-subserosal appendicitis.

Ezikhungweni zezempilo ezikude noma zasemakhaya ezingenayo i-ultrasound noma i-tomography, lo mkhuba uyindlela ebalulekile yokwenza izinqumo ukuze kuqinisekiswe ukudluliselwa okuphuthumayo esikhungweni sokuhlinzwa.

Indlela Yokusebenza Ngesinyathelo Ngesinyathelo

1. Isikhundla Sesiguli:

   • Isiguli sibekwe endaweni yokulala phansi (dorsal) , izingalo ezingezansi zigobile kancane phezu kwe-pelvis, ukuze kutholakale ukukhululeka okukhulu kwemisipha yodonga lwesisu sangaphambili.

2. Ukuhlola Okuhlanganisiwe Kwezandla Ezimbili:

   • Isandla Sangaphakathi (Ukuhlolwa Kwe-Rectal): umhloli ufaka umunwe wokukhomba (ogqokwe amagilavu ​​futhi ogcotshwe kahle) ku-ampulla ye-rectal, eqondisa isihloko somunwe odongeni olungaphambili kanye nesikhwama se-Douglas (noma i-rectovesical/rectuterine recess), esiqondisa ngakwesokudla.

   • Isandla Sangaphandle (Ukuhlikihla Isisu): esinye isandla sibekwa ngobumnene esikhumbeni se-iliac fossa yangakwesokudla (RIF).

3. Ukwenziwa Kokucindezela Kokuguqula:

   • Ngenkathi umunwe ose-rectum ucindezela phezulu nangaphandle ngokuqinile (ufuna indawo engezansi ye-pelvic noma isisekelo se-cecum), isandla sangaphandle senza ukucindezeleka kancane kancane nangokujulile phezu kwe-iliac fossa yangakwesokudla.

   • Inhloso "ukucindezela" izicubu eziphakathi kwesandla sesisu esehlayo nomunwe okhuphukayo.

Ukuhunyushwa Kwezokwelapha

• Umphumela Omuhle: Kubhekwa njengokuhle lapho ukucindezela kwe-bimanual kubangela ubuhlungu obukhulu, obubukhali, nobusendaweni ethile ku-ialac fossa yangakwesokudla , noma lapho kubangela ukuqaqamba kwemisipha okubonakalayo (ukuvikela imisipha) odongeni lwesisu okwakungabonakali ngokuthinta nje okungaphezulu.

• Indlela Yokwelapha Izifo: I-appendix evuvukele, endaweni engemuva noma ephansi, ihlukaniswe odongeni lwesisu olungaphambili ngama-loops amathumbu noma yi-cecum egcwele igesi. I-Yodice-Sanmartino maneuver isondeza i-posterior parietal peritoneum noma isikhwama sikaDouglas esivuvukele eduze kwesandla esihlolayo, ivuselela imicu ye-somatic nociceptive evusa i-visceral-cutaneous reflex.

Inani Lesayensi E-"Trench" Yasemakhaya

Uma uzithola usesikhungweni sezempilo esikude futhi ubhekene nenkinga yokuthi ngabe itshe lezinso, i-gastroenteritis, noma i-retrocecal appendicitis "efihliwe":

• Umehluko phakathi kobuhlungu be-parietal nobuhlungu obujulile besisu: uma ukucasuka okulula ku-fossa ye-iliac kwesokudla kungabaza, kodwa indlela ye-Yodice-Sanmartino ivusa ubuhlungu obubukhali nobungenakuphikwa, amathuba okuba nenqubo yokuvuvukala okubukhali ngaphakathi kwesisu noma emuva kwesisu adlula u-80%.

• Izindlela Zokuphuma Ngokuhlinzwa: Uma kungekho miphumela yelabhorethri noma yezithombe, isibonakaliso esihle se-Yodice-Sanmartino, kanye nomlando wezokwelapha wobuhlungu be-periumbilical kanye ne-tachycardia, kuyisibonakaliso esanele sokudlulisela isiguli ngokushesha esikhungweni sesibhedlela esinegumbi lokuhlinza.

Uphawu lukaDunphy, uRovsing, kanye noMeltzer

"Ezintanjeni" zemithi yasemakhaya noma ezindaweni ezikude, lapho singenayo khona i-ultrasound noma i-tomography, ukuhlolwa ngokomzimba okwenziwe kahle kuyithuluzi eliyinhloko lokusindisa izimpilo.

Izimpawu zikaDunphy , Rovsing, kanye noMeltzer zakha isisekelo sokuxilongwa kwe-appendicitis ebukhali emtholampilo, okuvumela ukuhlolwa kokucasuka kwe-peritoneum kanye nesimo somzimba se-appendix.

1. Isibonakaliso sikaDunphy: Ukuhlolwa Kokusheshisa Ukucindezeleka Kwangaphakathi Kwesisu

Isibonakaliso sikaDunphy sihlola ukuba khona kwe-parietal peritonitis ngokudlidliza kanye nokwanda okungazelelwe kwengcindezi emgodini wesisu.

Izinyathelo Zokusebenza Kobuchwepheshe:

1. Njengoba isiguli silele phansi noma simile, sicele ukuthi sivale umlomo waso bese senza ukukhwehlela okunamandla, okomile, okuzithandela.

2. Ezigulini zezingane noma kubantu abangakwazi ukukhwehlela ngomyalo, indlela efanayo iwukubacela ukuba bagxume ngonyawo lwabo lwesokudla noma bawele phansi kancane ezithendeni zabo kusukela ezinzwaneni zabo.

Ukuchazwa Kwezokwelapha:

• Okuhle: ukukhwehlela kubangela ubuhlungu obuhlabayo, obuhlabayo, nobusendaweni efanele ku-right iliac fossa (RIF).

• Indlela Yokwelapha: Uma ukhwehlela, i-diaphragm yehla ngokuzumayo futhi imisipha yesisu iyafinyela, okwandisa ukucindezeleka kwangaphakathi kwesisu. Lokhu kunyakaza kubangela ukuthi i-serosa ye-parietal peritoneum evuvukele ithinte udonga lwesisu, okubangela ubuhlungu bendawo nobubuhlungu. Inozwela oluphezulu kakhulu (90% kuya ku-95%) lokuqinisekisa ukucasuka kwe-peritoneal esebenzayo.

2. Isibonakaliso sikaRovsing: Ukudluliselwa Kwegesi Nokucindezela Kokubuyela Emuva

Uphawu lukaRovsing lusebenzisa ukuqhubeka kohlaka lwekholoni ukuze luhlukanise i-cecum kolunye uhlangothi lwesisu.

Izinyathelo Zokusebenza Kobuchwepheshe:

1. Beka isiguli endaweni yokulala phansi udonga lwesisu lukhululekile.

2. Beka izandla zakho ku- fossa yesobunxele ye-iliac (LIF) bese ucindezela ngokujulile nangokuqhubekayo.

3. Shelelezisa isandla sakho ngokuqinile ngendlela ebuyela emuva (phezulu), ulandela indlela yekholoni eyehlayo kanye nekholoni ye-sigmoid eya ekuguquguqukeni kwe-splenic.

Ukuchazwa Kwezokwelapha:

• Okuhle: Isiguli sibika ubuhlungu ku-RIGHT iliac fossa (hhayi ngakwesobunxele, lapho ucindezela khona).

• Indlela Yokwelapha Izifo: Ukuhlehla kwamagesi nokuqukethwe kwangaphakathi kwe-luminal kusuka kukholoni lwesobunxele kuya ku-cecum kwandisa ingcindezi yangaphakathi kwe-cecum. Lokhu kusabalala kwe-cecal kususa futhi kushukumise i-appendix evuvukele ngokumelene ne-peritoneum ye-parietal yesokudla, okuveza ubuhlungu be-appendicular obuyisici.

3. Isibonakaliso seMeltzer (Hausmann-Meltzer): I-Psoas Muscle Press

Isibonakaliso sikaMeltzer siwukuhlolwa kwe-semiological par excellence ukuthola i-appendicitis engemuva noma "efihliwe" , lapho ukuhlikihla okungaphezulu endaweni kaMcBurney kuvame ukuba mnene noma kube kubi ngokukhohlisayo.

Izinyathelo Zokusebenza Kobuchwepheshe:

1. Beka isiguli endaweni yokulala phansi.

2. Udokotela ohlinzayo ucindezela ngokuqinile nangokuqhubekayo ngesandla sakhe eqophelweni likaMcBurney (i-fossa ye-iliac yesokudla).

3. Ngesinye isandla sakho sisethangeni lesiguli, mcele ukuba aphakamise umlenze wakhe wesokudla ululiwe ngokuphelele (ngaphandle kokugoba idolo), anqobe ukumelana okubangelwa udokotela.

Ukuchazwa Kwezokwelapha:

• Okuhle: Ukuphakamisa umlenze ngokumelene nokumelana kubangela ubuhlungu obujulile nobunamandla ku-fossa ye-iliac yesokudla , okuphoqa isiguli ukuba siyeke umzamo.

• Indlela Yokwelapha Izifo: Uma umlenze oweluliwe uphakanyiswa ngokumelene nokumelana, imisipha ye-iliopsoas iyafinyela, ifinyele, futhi iqhume ngaphambili. Uma i-appendix ivuvukele futhi itholakala ngemuva kwe-cecum (retrocecal), i-psoas, efinyele ngaphakathi kwe-appendix, "iyayicindezela" esandleni sikadokotela, esisicindezelayo kusuka phezulu, ngaleyo ndlela sikhulise ubuhlungu bendawo.

I-Matrix ye-Semiological Utility ezindaweni ezingenazo izithombe

Isibonakaliso Sesayensi	I-Key Maneuver	Isibonakaliso Esiyinhloko Sezokwelapha	Iwusizo Kakhulu Ku:
Uphawu lukaDunphy	Ukukhwehlela okomile / Ukugxuma	Ubuhlungu obukhulu butholakala endaweni ye-iliac fossa yangakwesokudla ngokukhwehlela	Ukucasuka okukhulu kwe-peritoneal parietal
Uphawu lwe-Rovsing	Ukucindezela ku-FII	Ubuhlungu bubhekiselwe ku-FID ngenxa yegesi yamathumbu amakhulu	I-appendicitis yangaphambi kwesifo ezigabeni zokuqala
Uphawu lwe-Meltzer	Ukuphakama kwemilenze + ingcindezi ye-FID	Ubuhlungu obujulile obubangelwa ukufinyela kwemisipha ye-psoas	I-appendicitis ye-Retrocecal ("efihliwe")

ukuxilongwa okuhlukile

Ukuxilongwa okuhlukile kungaba nzima kakhulu ezimweni ze-occult appendicitis. Lolu hlobo lwe-appendicitis olungaziwa kangako alubonakali ngamasu endabuko okuthwebula izithombe futhi lungabonakala ngezimpawu ezifana nezezifo ezivamile zesisu, njenge-irritable bowel syndrome noma i-reflux.

Uma lungelashwa, lolu hlobo lwe-appendicitis lungaholela ekubhobokeni kwamathumbu noma i-peritonitis . Ukuhlukanisa phakathi kwalezi zifo ezimbili kudinga ukuqashelwa ngokucophelela nguchwepheshe wezempilo, kanye nomlando wezokwelapha onemininingwane wesiguli.

I-appendicitis ingaphinde ididaniswe nezimo ezingengozi kakhulu, njenge-gastroenteritis, ubuhlungu bamatshe ezinso, noma isifo sokuvuvukala kwe-pelvic; noma kunjalo, kubalulekile ukuthi odokotela baqaphele ukuthi kungenzeka ukuthi kutholakale isifo esingalungile futhi bathathe izinyathelo zokuhlola noma yikuphi ubuhlungu besisu obusolisayo noma obungachazeki.

Izindlela zokuxilonga, njengokuhlolwa kwegazi, kanye nokuhlolwa ngokomzimba, njengokusebenzisa i-auscultation kanye ne-percussion, zingase zithole ubuthakathaka engxenyeni engezansi kwesokudla, okuzokwazisa udokotela ukuthi kudingeka uphenyo olwengeziwe.

Uma kutholakala kusenesikhathi, ukwelashwa kwe-occult appendicitis kungase kuhlanganise ama-antibiotic esikhundleni sokuhlinzwa, okwenza ukuxilongwa kusenesikhathi kubaluleke nakakhulu ezigulini.

Ukwelashwa kwe-Appendicitis

Ukwelashwa kwe-appendix evuvukele ukususwa kwayo ngokusebenzisa inqubo yokuhlinzwa eyaziwa ngokuthi i-appendectomy.

Izindlela zamanje, njenge-laparoscopy, azihlanganisi kakhulu futhi zinikeza ubuhlungu obuncane, amanxeba amancane, kanye nesikhathi esifushane sokuphulukiswa nokululama kunokuhlinzwa okuvulekile okuvamile.

Kodwa-ke, uma i-appendix iqhumile noma uma isiguli sibhekene nezinkinga, ukuhlinzwa okuvulekile cishe kuzodingeka. Kubalulekile ukufuna usizo lwezokwelapha ngokushesha lapho ubona izimpawu ezicashile ze-appendicitis ukuze kuncishiswe izinkinga ezingaba khona futhi kuthuthukiswe ukubikezela.

Ngemva kokuhlinzwa, isiguli kungadingeka sihlale esibhedlela izinsuku ezimbalwa ukuze siqashwe futhi sinikezwe ama-antibiotic ngemithambo yegazi ukuze kuvinjelwe noma kulawulwe ukutheleleka. Imithi yobuhlungu inganikezwa futhi ukuze kulawulwe ukungakhululeki.

Kubalulekile ukulandela imiyalelo kadokotela mayelana nokunakekelwa kwendawo yokuhlinzwa futhi ugweme ukwenza umsebenzi onzima womzimba uze ululame ngokugcwele.

Ezimweni ezingavamile, i-appendicitis encane ingelashwa ngama-antibiotic kuphela, ngokuvamile kubantu abangafaneleki ukuhlinzwa ngenxa yezimo zezokwelapha ezazikhona kakade njengomfutho wegazi ophakeme ongalawuleki, isifo sikashukela esingalawuleki, i-hypothyroidism, noma i-hyperthyroidism.

Ukuvimbela ukuvuvukala kwe-vermiform appendicular

I-occult appendicitis yisimo esingaba yingozi kakhulu esingaba nzima kakhulu ukusibona nokuyixilonga. Sibonakala ngokuvuvukala kwe-appendix, okubangelwa ukuvaleka komgodi wayo (yizinto zangaphandle, njengembewu, amagciwane, noma amathumba) noma ngokuqongelela kwendle eqinile.

Ukuvimbela i-occult appendicitis kufezwa ngokukhetha indlela yokuphila. Ukukhuluphala ngokweqile kanye nendlela yokuphila yokuhlala phansi, kokubili okuhambisana nokudla okungenampilo okune -fiber eningi kanye nokuntuleka kokuzilolonga, kungandisa ingozi yokuthola i-occult appendicitis ngenxa yokucindezeleka okukhulu emathunjini.

Ukulandela ukudla okunempilo, ukwenza umsebenzi ojwayelekile womzimba njengokugijima, ukubhukuda, ukugibela ibhayisikili, noma ukulandela uhlelo lokuzivocavoca, nokuqinisa imisipha kungasiza abantu ukuba balondoloze isisindo sabo futhi bagweme izinto ezingaba yingozi yokuvuvukala nokuvaleka kwe-appendix.

Ukuvimbela, njengento ebalulekile kulesi sifo, kumele kucatshangelwe ngokungathi sína, njengoba kungaba kubi kakhulu uma ukungakhululeki kokuqala okucashile kungabonwa futhi kungelashwa.

Ukuhlaziywa kwenani

Indlela Yokwenza Izinto Ezingokwesayensi Yesibonakaliso SaseSan Martino NamaPsoas:

UDkt. Delgado uletha inani eliyingqayizivele lokufundisa okusezingeni eliphezulu ngokuchaza ngokuningiliziwe izivivinyo zomzimba zokuthola i-retroperitoneal pathology.

Ukufundisa ukuthi esigulini esinobuhlungu obungacacile nobungacacile bomhlane ongezansi ohlangothini lwesokudla, ukunwetshwa kwe-hip kwesokudla ( uphawu lwe-psoas ) noma ukuhlikihla okujulile kwe-bimanual okucindezelwe ku-lumbar fossa yesokudla kwandisa ubuhlungu ngokwelula imisipha ye-psoas evuvukele yi-retrocecal appendage, kugwema iphutha elibi lokukhipha isisu ngokuxilongwa "kobuhlungu bemisipha ephansi yomhlane".

Umbono Wezemfundo Nobuprofesa (UMnyango Wezokuhlinzwa - IYunivesithi yaseCuenca):

Umehluko usekelwe kumasu e-laparoscopic okuhlinzwa kwe-subserosal retrocecal appendectomy.

Njengoprofesa waseyunivesithi, ngifundisa izakhamuzi kanye nabafundi abaqeqeshwayo ukuthi lapho behlinza i-appendicitis efihliwe nge-laparoscopically, udokotela ohlinzayo akufanele azame "ukudonsa" i-appendix ngokungaboni nge-forceps (njengoba lokhu kungaphula isakhiwo esibhibhayo).

Indlela yokuphepha idinga ukuhlanganiswa kwe-cecum ngokukhipha indawo yokugoqa ye-parietocolonic kwesokudla (i-Kocher/Toldt maneuver kwesokudla) ukuze kuvezwe i-fascia kaGerota kanye nesikhala se-retrocecal ngaphambi kokusondela esisekelweni.

Isiphetho

Ekuphetheni, iphuzu elibalulekile: i-acute appendicitis yisimo esibi esidinga ukunakekelwa kwezokwelapha ngokushesha . Izimpawu zingaba zicacile futhi ziphazanyiswe kalula nezinye izifo, ngakho-ke ukuxilongwa kusenesikhathi kubalulekile ukuze kube nesibikezelo esihle kanye nokululama.

Ukulungiswa kwerekhodi lezokwelapha kanye nokuhlolwa ngokomzimba nguchwepheshe ngokuvamile kuyisinyathelo sokuqala sokuxilonga i-appendicitis, futhi ngokuvamile ukungenelela kokuhlinzwa kuyadingeka ukuze kususwe i-appendix evuvukele.

Uma wena noma othile omaziyo ebhekene nezimpawu ze-appendicitis ebukhali, funa usizo lwezokwelapha ngokushesha ohlelweni lokunakekelwa kwempilo lukahulumeni noma oluzimele ukuze uqinisekise ukuthi uthola umphumela ongcono kakhulu.

Lesi yisikhathi sobumbano njengoba sabelana ngolwazi lwezempilo lokuvimbela mayelana ne-appendicitis ezinkundleni zokuxhumana. Ngokusebenzisana, singaqinisekisa ukuthi umndeni, abangani, nabanye bayaziswa, bayaqaphela izimpawu zokuqala ezincane, futhi bafuna usizo lwezokwelapha ukuze bagweme izinkinga ezinkulu.

Ngiyabonga ngokushiya amazwana akho kanye neziphakamiso zebhulogi yezempilo yokugaya ukudla. Ngikuthumelela ukwanga okukhulu futhi sizobonana kokuthunyelwe okulandelayo!

UDkt. Jorge Delgado, Udokotela Ohlinzayo. I-Appendicitis Efihliwe. 

📌 Ukufundwa okunconyiwe:

👨‍⚕️ Umhlahlandlela we-anatomy ye-topographic, ukuhlukahluka kwesimo kanye nephuzu likaMcBurney.

👨‍⚕️ Ukuhlaziywa kokucasuka kwe-rectal/sigmoid ngenxa yesimo se-pelvic.

👨‍⚕️ Izigaba zokuziphendukela kwemvelo, i-pathophysiology kanye nokuqhubekela phambili ekubhobokeni.